Mess with health care — especially if you’re closing hospitals — and you’re bound to get a reaction. That’s exactly what Nova Scotia Premier Stephen McNeil got on Monday when he announced that two Cape Breton hospitals were closing, and that two other hospitals would be enlarged to take over care for the closed units.

The changes included closing Northside General Hospital in North Sydney, a hospital that opening in 1954, and New Waterford Consolidated Hospital, which opened in 1964. The plan is to replace the hospitals with collaborative health centres, but both areas will lose their emergency rooms. In some ways, that’s not surprising: the two hospital already suffered from doctor and other staffing shortages that led to the two emergency rooms being among the top three most-frequently closed emergency rooms in that province.

It would be easy to ride the public outrage wave, and simply say that the closures were unfair and demand that the government ought to overturn them.

But the truth is that, across all four Atlantic provinces, health care is the single most expensive item in any provincial budget. In fact, health care is far and away the most expensive service that provincial governments have to fund. And the costs are rising every single year.

If we don’t give our provincial governments the leeway to make changes — something that seems especially the casein the Cape Breton, where the hospitals being closed are relatively small operations in dated builds, and in areas like rural Newfoundland as well — we’re not going to be able to afford care.

Emergency rooms are among the most expensive services to provide —- they are fully staffed with specialized staff 24 hours a day, and that staffing is required even if there aren’t patients to care for, and even if, in the case of areas with shortages of family doctors, highly trained emergency medicine specialists are dealing with a long lineup of minor ailments, from colds and flus to ear infections in children. Emergency rooms certainly have to be close enough to help patients who need urgent care, but they also have to have enough patients to make their substantial expense worthwhile.

We have to be more strategic about how we spend health-care dollars: some health-care systems, for example, are setting up systems to ensure their diagnostic imaging services are used to the fullest, ensuring that patients are contacted in the days leading up to their appointments, and if appointments are cancelled, filling those spots with people from a readily available wait list instead of simpler letting equipment and trained staff sit idle.

It’s worth thinking as well that, when hospitals like Northside and New Waterford were opened, the entire medical-care system was different: patients who needed emergency care were simply taken as quickly as possible to medical care. Ambulances weren’t crewed with primary-care paramedics, let alone advanced-care paramedics, whose job it is, often, to stabilize patients before they even begin their trip to an emergency room.

All sorts of things have changed in medical care, from the size of equipment to the specialization of treatment to the scheduling of procedures that are better done at larger, more centralized hospitals.

If every single change or closure is going to be a battle to the death, it’s easy to understand why provincial governments would be leery of doing anything. The problem is that, for health care, the status quo can’t continue. Not unless, of course, we all agree to pay a substantially larger amount of taxes to pay for it.

And I don’t see anyone putting up their hands to volunteer for that.

Russell Wangersky’s column appears in 39 SaltWire newspapers and websites in Atlantic Canada. He can be reached at russell.wangersky@thetelegram.com — Twitter: @wangersky.